Objective To investigate the synergistic protective effects of WR-2721 combined with lentinan and cytokines against radiation damage in mice, and to provide a new treatment for acute radiation injury. Methods Seventy Institute of Cancer Research mice were divided into seven groups: a control group, a model group, WR-2721 group, Lentinan & cytokine group, WR-2721 & Lentinan group, WR-2721 & cytokine group and WR-2721 & Lentinan & cytokine group. All groups except the control group were irradiated with ⁶⁰Co γ-rays at a dose rate of 0.8 Gy/min and a cumulative dose of 5.0 Gy. The mice were sacrificed by cervical dislocation 14 d after irradiation to measure their spleen index, thymus index, and serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-11 (IL-11), and tumor necrosis factor-alpha (TNF-α). Results For the mice treated with WR-2721, lentinan, and cytokines, the spleen index was 7.33 ± 2.84, the thymus index was 1.70 ± 0.30, the serum SOD level was 114.0 ± 8.3, the MDA level was 7.33 ± 1.16, the IL-11 level was 155.8 ± 49.4, and the TNF-α level was 174.0 ± 37.8. All these indicators except the spleen index in the combination group significantly differed from those of the model group (P < 0.05 or 0.01), indicating the combined treatment promoted recovery from radiation damage. Conclusion WR-2721 combined with lentinan and cytokines has significant synergistic protective effects, which is a promising treatment for acute radiation injury.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

Objective:To establish a scientific and standardized routine for perioperative nursing in pediatric otolaryngology, reduce the incidence of postoperative delirium, and improve the quality of postoperative recovery by implementing the best practice of evaluation and intervention of postoperative delirium in pediatric otolaryngology.Methods:By reviewing literature related to evaluation, prevention, intervention and management of postoperative delirium in pediatric otolaryngology from March 2018 to September 2019, fourteen best practice were concluded. By combining the best evidence and the clinical circumstances, the evidenced-based criteria were established and then applied in the Otolaryngology and Head and Neck Surgery Department, the Children ′s Hospital of Zhejiang University School of Medicine. Results:After three rounds of reviews, the results showed that the criteria 2, 3, 6, and 8 had 100.0% complacence. Comparison of before and after applying the evidence, there was no statistically significant difference for the occurrence of postoperative delirium or pain ( P>0.05); there was a statistically significant reduction of pain score at 60 minutes after returning to the ward ( χ2=9.93, P<0.05); there was a statistically significant reduction of preoperative anxiety score of children ′s family members from (33.36 ± 6.84) points to (29.54 ± 6.94) points ( F=6.33, P<0.05); there was a statistically significant increase of doctors ′ score of delirium knowledge based on evidence from (23.00 ± 3.94) points to (33.43 ± 8.25) points ( t=-3.02, P<0.05); and there was a statistically significant increase of nurses ′ score of delirium knowledge based on evidence from (33.11 ± 8.46) points to (57.79 ± 6.58) points ( t=-10.35, P<0.05) when the evidence was applied. Conclusion:The evidence-based practice didn ′t significantly relieve the postoperative delirium in pediatric otolaryngology, but it was helpful to relieve the postoperative pain level of children and the anxiety level of their families. The management of postoperative delirium in pediatric otolaryngology needs to be further explored.

OBJECTIVE： To study the effects of cimetidine on low dose rate irradiation-induced liver cell apoptosis in Beagle dogs. METHODS： Healthy male Beagle dogs were randomly divided into normal control group， model control group， positive drug group （lentinan， 21.33 mg/kg） and cimetidine low-dose， medium-dose and high-dose groups （5.33， 10.67， 21.33 mg/kg）， with 4 Beagle dogs each. Except for normal control group， other groups were given 60Co-γ accumulative irradiation （dosage rate： 0.040 8 mGy/min） for 23 d； the medication groups were given relevant medicine orally before irradiation， once a day. Twenty-four hours after stopping irradiation， TUNEL method was used to detect the apoptosis of liver cells in Beagle dogs. The percentage of apoptotic cells was calculated. The expression level of apoptosis-related proteins （Bax， Bcl-2， Caspase-3， p53） in liver tissue was detected by immunohistochemistry. RESULTS： Compared with normal control group， apoptotic cells and Bax， Caspase-3， p53 positive cells were increased significantly in liver tissue of Beagle dogs in model control group； the percentage of apoptotic cells， protein expression levels of Bax， Caspase-3 and p53 were increased significantly； Bcl-2 positive cells were decreased significantly， and its protein expression level was decreased significantly （P＜0.05 or P＜0.01）. Compared with model control group， above positive cells of liver tissue in Beagle dogs were changed to different extents in medication groups； the percentage of apoptotic cells and protein expression levels of p53 in medication groups， protein expression levels of Bax in positive drug group， cimetidine low-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were decreased significantly； protein expression levels of Bcl-2 were increased significantly in cimetidine groups. The percentage of apoptotic cells in cimetidine medium-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were all lower than positive control group. Protein expression level of p53 in cimetidine low-dose group was significantly higher than positive drug group （P＜0.05 or P＜0.01）. CONCLUSIONS： Cimetidine can inhibit the low dose rate irradiation-induced apoptosis of liver cells in Beagle dogs， and certainly protect liver cells against irradiation. The mechanism of it may be associated with up-regulating the protein expression of Bcl-2 and down-regulating the protein expression of Bax， Caspase-3 and p53 in liver cells.

Objective To investigate the radioprotective effect of cimetidine on survival rate and hematopoietic system in acutely irradiated mice.Methods The total body irradiation doses were 6.0Gy and 8.0Gy respectively at 1.01Gy/min rate. Sixty healthy male C57BL/6 mice were randomly divided into control group, model group, positive-drug (523) group and cimetidine groups (33.3mg/kg, 100mg/kg and 300mg/kg). Each group had ten mice. The mice were given intragastric administration of cimetidine for 6d before the irradiation in cimetidine groups, and 523 was administered before irradiation once a day for one day in 523 group, and at 5h after irradiation, was given again. The 30d survival rate after 8.0Gy irradiation was recorded. The peripheral blood cells, bone marrow DNA content and frequency of micronucleated polychromatic erythrocytes (fMNPCE) were determined 30d after 6.0Gy irradiation.Results After 8.0Gy irradiation, all the mice died on 21th day in model control group. The survival rates in cimetidine groups were 50%, 20% and 30%, respectively. After 6.0Gy irradiation on 30th day, compared with control group, the peripheral white blood cells (WBC) and bone marrow DNA content were decreased significantly (P<0.01,P<0.05) in model group, and fMNPCE was increased significantly (P<0.05). Compared with model group, WBC was significantly increased in 300mg/kg cimetidine group (P<0.01). In cimetidine groups, the bone marrow DNA content was increased significantly after irradiation (P<0.01 orP<0.05), and the fMNPCE was decreased significantly (P<0.01 orP<0.05) and tended towards normal.Conclusion Cimetidine could improve 30d survival rate of acutely irradiated mice and has good protective effect on hematopoietic system.

Objective:To observe the temperature vaxiation in the pulp chamber during Nd-YAG laser irradiation at tooth cervical portion.Methods:60 extracted permanent teeth were divided into 3 groups (anterior teeth,premolars and molars,n =20).The teeth in each group were further divided into 4 subgroups according to the laser power setting (0.4 W,0.8 W)and interval time(1 0 s,20 s)(n =5).After canal preparation the teeth were fixed and filmed using the parallel projection technique.the thickness of the buccal pulp chamber wall was measured by graphic analyzing software.The buccal cervical portion of the teeth was irradiated through 200 μm optical fiber,Temperature in the pulp was measured by K type thermo-electric couples fixed to the pulp chamber wall.Re-sults:The temperature inside the chamber increased with the higher power setting(P <0.01 ),under the same power setting,longer irradiation duration caused higher temperature rise(P <0.01 ).Greater chamber wall thickness was associated with lower temperature rise.Conclusion:The temperature rise in the pulp chamber during laser irradiation is correlated with laser power setting and the thickness of the irradiated tooth tissue.

Objective:To prepare old tea buccal tablets using wet granulation method and optimize the preparation technology. Methods:The amount of each adjuvant was studied by single factor experiments, and the formula of the buccal tablets was optimized by the orthogonal experiments using taste and disintegration time as indices. Results:The optimal formula was composed of old tea ex-tract 30 g,mannitol 60g,PEG6000 20 g,aspartame 10 g,citric acid 10 g and menthol crystal 1 g. All the tested indices including ap-pearance, hardness and disintegration time met the requirements described in Chinese pharmacopeia. Conclusion: The preparation technology is reasonable and feasible for the industrial production.

Objective:To establish the quality standard for Sipunculus nudus polysaccharide. Methods:The water content, igni-tion residues and heavy metals in Sipunculus nudus polysaccharide were determined. Authrone-sulfuric acid colorimetry was used to de-termine the polysaccharide content. Results: The water content in the polysaccharide should not exceed 5. 0%, ignition residues should not exceed 1. 0%, and the content of heavy metals should not exceed 20 ppm. The polysaccharide content should exceed 80%( glucose) . Conclusion:The method is accurate and simple, and can be effectively used in the quality control of polysaccharide in Sipunculus nudus Linnaeu.

OBJECTIVETo assess the temperature variation of the root surface using Nd: YAG laser irradiation in the root canal with different power and to evaluate the safety of laser application on the periodontal region.

METHODSThirty extracted human teeth with single-roots were collected. The teeth were cross-sectioned in the cervical portion, standardizing the roots at a 12-mm length. The roots were used as specimen. The roots were radiographed in the buccal-lingual direction to measure the thickness of the proximal walls, by means of a digital radiographic system. The specimens were divided into three groups according to the laser potency (1.5, 3.0, and 4.5 W). Each group was subdivided into two subgroups according to laser frequency (15 and 30 Hz). With the Nd: YAG laser irradiation for 20 s, the temperature variation of the root surface was monitored by thermocouples located at different parts of the root external wall and recorded by digital thermometers.

RESULTSThe groups irradiated with 4.5 W presented the greatest temperature variation (above 10°C), followed by 3.0 and 1.5 W. The temperatures were statistically different (P < 0.01). The groups irradiated in the same potency, regardless of whether 15 Hz or 30 Hz was used, presented with no statistical difference (P > 0.05). The apical half of the root presented statistically higher temperature rises than the cervical half of the root (P < 0.01).

CONCLUSIONThe temperature variation of the root surface was associated with laser power, irradiation time, and the thickness of dentin. Application of Nd: YAG laser in the root at 1.5 W for 20 s can safely be used in endodontic treatment.

Objective To assess the temperature variation of the root surface using Nd:YAG laser irradiation in the root canal with different power and to evaluate the safety of laser application on the periodontal region. Methods Thirty extracted human teeth with single-roots were collected. The teeth were cross-sectioned in the cervical portion, standardizing the roots at a 12-mm length. The roots were used as specimen. The roots were radiographed in the buccal-lingual direction to measure the thickness of the proximal walls, by means of a digital radiographic system. The specimens were divided into three groups according to the laser potency (1.5, 3.0, and 4.5 W). Each group was subdivided into two subgroups according to laser fre-quency (15 and 30 Hz). With the Nd:YAG laser irradiation for 20 s, the temperature variation of the root surface was moni-tored by thermocouples located at different parts of the root external wall and recorded by digital thermometers. Results The groups irradiated with 4.5 W presented the greatest temperature variation (above 10 ℃), followed by 3.0 and 1.5 W. The temperatures were statistically different (P<0.01). The groups irradiated in the same potency, regardless of whether 15 Hz or 30 Hz was used, presented with no statistical difference (P>0.05). The apical half of the root presented statistically higher temperature rises than the cervical half of the root (P<0.01). Conclusion The temperature variation of the root surface was associated with laser power, irradiation time, and the thickness of dentin. Application of Nd:YAG laser in the root at 1.5 W for 20 s can safely be used in endodontic treatment.